Programme no. 428-OP
Investigating the Value of Susceptibility Testing as a Point of Care Test.
A Randomized Controlled Trial in General Practice
Anne Holm*1, Lars Bjerrum2
1Section of General Practice, Dept. of Public Health,Copenhagen University,1014 København K,Denmark, 2Section of General Practice, Dept. of Public Health,Copenhagen University,1014 København K,Denmark
* = Presenting author
Objectives: The aim of this study is to investigate whether point of care susceptibility testing and targeted antibiotic treatment of patients with uncomplicated urinary tract infection in general practice will improve correct choice of antibiotic, clinical remission and bacteriological cure rate compared to urine culture without susceptibility testing and empiric treatment.
Background: Antibiotic resistance is one of the most important threats to human health. Primary health care in Denmark prescribes 90% of all redeemed prescriptions of antibiotics and it is known that a high outpatient consumption of antibiotics leads to high levels of resistance . In 2008, 1.8% of all patients consulting their general practitioner (GP) in 2008 were diagnosed with a urinary tract infection (UTI) and resistance levels in E. Coli in urine samples is now the same in primary care as in the hospital sector in Denmark. With increasing resistance, the need for precise microbiological diagnosis will increase. Earlier studies have shown divergent results with regards to the value of point of care susceptibility testing (POCsT). Since, new media have been introduced for POCsT, and results of validation studies are promising. This study investigates the value of POCsT in primary care.
Results: So far 17 GP clinics with 32 GPs have been recruited. They are receiving training in POCsT and are completing an online test. The pilot study will run in December 2014 and January 2015. Inclusion of patients will begin in March 2015.
Material/Methods: 750 patients with symptoms of uncomplicated urinary tract infection, consecutively contacting their GP, randomized to either urine culture and empirical treatment or urine culture and susceptibility testing and targeted treatment. Culture and susceptibility testing is performed as point of care tests. All patients fill out a symptom-diary and have control urine sent to the microbiological department on day 1 and 14.
Conclusion: There is an increasing need for precise microbiological diagnosis in primary care and POCsT could be a way to be guided towards a good choice of antibiotic.
Points for discussion:
How much better should the intervention group perform to justify susceptibility testing for uncomplicated urinary tract infection?
We have chosen to delay treatment for one day until the test result is ready. How acceptable would this be in other countries?